Successful control of rapid heart rate in a patient with atrial fibrillation by continuous intravenous administration of landiolol hydrochloride

A 79-year-old man with atrial fibrillation underwent total pharyngolaryngectomy and free flap reconstruction for hypolaryngeal cancer under general anesthesia. He developed tachyarrhythmia with ST depression and inverted T wave. The treatment including sufficient fluid therapy, continuous administration of vasodilator and intravenous digoxin failed to control the abnormalities. Then landiolol hydrochloride, a new cardioselective ultra-short acting beta-blocker, was continuously administered. Despite the relatively low doses with 1 min loading infusion at 0.04 mg.kg-1.min-1 and continuous infusion at 0.016 mg.kg1.min-1, rapid control of heart rate occurred in a few minutes and inverted T waves were normalized in fifteen minutes. There was no significant change of peripheral blood pressure. The present case suggests that landiolol hydrochloride is effective in controlling heart rate in a patient with atrial fibrillation and that the optimal dose should be carefully evaluated for each case.